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S. Pagliarini, MD; A. Moramarco, MD; R. P. L. Wormald, MSc; B. Piguet, MD; C. Carresi, MD; C. Balacco-Gabrieli, MD; K. S. Sehmi; Alan C. Bird, MD

Arch Ophthalmol. 1997;115(5):616-622.

Abstract
Objective
To report the prevalence of age-related maculopathy (ARM) in Salandra, a small, isolated southern Italian community, to test the hypothesis that an environmental factor, scarce in such a remote community but ubiquitous in modern industrial societies, might modify the risk of developing ARM.

Design
Population-based cross-sectional survey.

Main Outcome Measures
Prevalence of advanced age-related macular degeneration (ARMD) (geographic atrophy or exudative maculopathy) and ARM (large, soft drusen or retinal pigment epithelium changes, or both) defined by fundus biomicroscopy and 30° stereoscopic macular photography. Self-sustenance was assessed by interview of participants and local shop retailers. The degree of genetic isolation was computed using a model that fits the genetic population structure with the frequency distribution of surnames in the community.

Results
A full ophthalmic examination was undertaken in 366 (63.5%) of 576 eligible participants, 354 (96.7%) of whom had clinical or photographic assessment for the presence of ARMD and 310(84.6%) of whom had drusen characteristics graded on color transparencies for ARM. The overall prevalence of ARMD was 1.1%. Drusen larger than 50 µm and more numerous than 10 were found in 4.5% of subjects. Salandra was the birthplace of 87.2% of participants and for 77.3% of both parents of each subject. People in the community tended to consume homegrown products.

Conclusion
The prevalence of ARM may be lower in this self-sustained farming community than elsewhere in the industrialized world.

Author Affiliations
From Queen's Medical Centre, University Hospital, Nottingham, England (Dr Pagliarini);The Institute of Ophthalmology, University College of London, London, England (Drs Wormald, Piguet, and Bird and Mr Sehmi); and the Istituto di Oftalmologia, Chief C. Balacco-Gabrieli, Policlinico Umberto I, University "La Sapienza," Roma, Italy (Drs Moramarco, Carresi, and Balacco-Gabrieli).

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